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Library of Congress Cataloging-in-Publication Data

Young, Simon, 1971- , author.
    Medicines management for nurses at a glance / Simon Young, Ben Pitcher.
      p. ; cm. – (At a glance series)
    Includes index.
      ISBN 978-1-118-84072-6 (paperback)
    I. Pitcher, Ben, 1979-, author. II. Title. III. Series: At a glance series (Oxford, England)
    [DNLM: 1. Drug Therapy–nursing–Great Britain. 2. Drug Prescriptions–nursing–
    Great Britain. 3. Drug Therapy–methods–Great Britain. 4. Nurse Clinicians–Great
    Britain. WY 100 FA1]
       RT68
      615.1'4–dc23

2015033805

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: GettyImages-478860007/sturti

CONTENTS

Preface

About the companion website

Part 1: Introduction to pharmacology and medicines management

Chapter 1: Why is managing medicines important in nursing?
1. Medicines management and nursing
2. Defining medicines management
Chapter 2: Keeping up to date with medicines management
1. Continuing professional development
2. Post-registration educational practice
Chapter 3: What is a medicine?
1. How are medicines developed and monitored?
Chapter 4: Medicines nomenclature: what’s in a name?
1. Endings
Chapter 5: Numeracy and medicines management
1. Symbols
2. Illustrative biological unit standards for medicinal products
Chapter 6: Clinical pharmacokinetics I
1. Absorption
2. Distribution
Chapter 7: Clinical pharmacokinetics II
1. Metabolism
2. Excretion
Chapter 8: Routes of administration I
1. Oral
2. Intravenous
3. Intramuscular
4. Subcutaneous
Chapter 9: Routes of administration II
1. Inhaled
2. Topical
3. Transdermal
4. Sublingual
5. Rectal
Chapter 10: Pharmacodynamics I
1. What is pharmacodynamics?
2. Why do chemicals have such varied but specific effects on the body?
3. Receptors
4. Second messenger systems
5. Ion channels
Chapter 11: Pharmacodynamics II
1. Agonists and antagonists
2. Receptor specificity
3. Enzymes

Part 2: Managing medicines

Chapter 12: Dyspepsia
1. Dyspepsia
2. Antacids
3. Histamine (H2) antagonists
4. Proton pump inhibitors (PPIs)
Chapter 13: Acute diarrhoea and constipation
1. Acute diarrhoea
2. Constipation
Chapter 14: Chronic bowel disease
1. Medications
2. Aminosalicylates
3. Corticosteroids
4. Immunoregulating agents
Chapter 15: Nausea and vomiting
1. Medications
2. Metoclopramide
3. Antihistamines
4. 5-HT₃ receptor antagonists
Chapter 16: Anti-anginals
1. Indications
2. Nitrates
3. Calcium channel blockers
Chapter 17: Anti-arrhythmics
1. Digoxin
2. Amiodarone
3. Other anti-arrhythmic drugs
Chapter 18: Heart failure
1. Angiotensin converting enzyme (ACE) inhibitors
2. Angiotensin-II receptor antagonists
3. Other drugs used in heart failure
Chapter 19: Hypertension
1. Drugs used to treat hypertension
2. Beta-blockers
3. Calcium channel blockers
4. Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBS)
5. Diuretics
6. Other drugs used in hypertension
Chapter 20: Diuretics
1. Pharmacodynamics
Chapter 21: Respiratory conditions I
1. Bronchodilators
2. Adrenoceptor agonists
3. Antimuscarinic bronchodilators
4. Theophylline and aminophylline
5. Inhaled corticosteroids
6. Leukotriene receptor antagonists
Chapter 22: Respiratory conditions II
1. Decongestants
2. Mucolytics
3. Antihistamines
4. Oxygen
Chapter 23: Opioid analgesics
1. Opioid analgesics
2. Commonly used opioid analgesics
Chapter 24: Anxiolytics and hypnotics
1. Benzodiazepines
2. Buspirone
3. Antidepressants and beta-blockers
4. Hypnotics – the ‘Z’ drugs (Zaleplon, Zopiclone and Zolpidem)
Chapter 25: Antipsychotics
1. First-and second-generation antipsychotics
Chapter 26: Depression
1. SSRIs
2. Tricyclic and related antidepressants
3. Other antidepressants
Chapter 27: Epilepsy
1. Anti-epileptic medication
2. Valproate
3. Carbamazepine
4. General advice
Chapter 28: Alcohol: detoxification
1. Medication that aids in the detoxification process
2. Thiamine and B vitamins
Chapter 29: Alcohol: maintaining abstinence
1. Acamprosate
2. Disulfiram
3. Naltrexone
Chapter 30: Smoking cessation
1. Pharmacodynamics
2. Pharmacokinetics
Chapter 31: Fighting infection
1. Bacteria
2. Viruses
3. Fungi
4. Other organisms
Chapter 32: Antibiotics
1. Penicillins
2. Cephalosporins
3. Other beta-lactam antibiotics
4. Beta-lactamases and inhibitors
5. Tetracyclines
6. Macrolides
7. Aminoglycosides
8. Metronidazole
Chapter 33: Diabetes: insulin
1. Insulins
Chapter 34: Diabetes: antiglycaemics
1. Biguanides
2. Sulfonylureas
3. ‘Other’ antidiabetics
4. Incretin mimetics
5. DPP-4 inhibitors
6. Pioglitazone (Actos®)
Chapter 35: Thyroid conditions
1. Hypothyroidism
2. Antithyroid drugs
Chapter 36: Oral contraception
1. Hormonal contraception
2. Medications
Chapter 37: Anticoagulants
1. Anticoagulants and the clotting cascade
Chapter 38: Antiplatelet drugs
1. Aspirin
2. Clopidogrel (Plavix®)
3. Dipyridamole
4. Other antiplatelets and anticoagulants
Chapter 39: Musculoskeletal disorders
1. Gout
2. Allopurinol
3. Colchicine
Chapter 40: Non-steroidal anti-inflammatory drugs and non-opioid analgesics
1. Non-steroidal anti-inflammatory drugs
2. Details of common NSAIDs
3. Non-opioid analgesics
Chapter 41: Topical agents and emollients
1. Fingertip units
2. Emollients
Chapter 42: Topical steroids
1. Topical steroids combined with antimicrobial agents
2. Treatments for psoriasis

Part 3: Safe and effective medicines management

Chapter 43: Medicines management in pregnancy and breastfeeding
1. General principles to using medicines in pregnancy
2. General approaches to using medicines during breastfeeding
Chapter 44: Medicines management in children
1. Key medicines management issues for children
Chapter 45: Medicines management in elderly people
1. National Service Frameworks
2. Key medicines management issues for elderly patients
3. Ageing
4. Adherence
Chapter 46: Medicines management in people with hepatic and renal impairment
1. Managing medicines in hepatic impairment
2. Managing medicines in renal impairment
3. Examples of when drug and renal function are considered
Chapter 47: Drug interactions
1. Why are drug interactions important?
2. Classification of drug interactions
3. Underlying factors
Chapter 48: Adverse drug reactions
1. Why are adverse drug reactions important?
2. Classification of adverse drug reactions
3. The features of Type A reactions
4. The features of Type B reactions
5. Predisposing factors
Chapter 49: Pharmacovigilance
1. What is pharmacovigilance? Why is it important?
2. What methods are used to monitor the safety of medicines on the market?
3. Possible actions to be taken
Chapter 50: Classification of medicines
1. Classification of medicines in the UK
2. Controlled drugs

Index

Eula

List of Illustrations

Chapter 1

Figure 1.1 An overlapping Venn diagram illustrating the Nursing and Midwifery Council’s elements of the medicines management skills cluster

Chapter 2

Figure 2.1 An example of how even widely used medications can have significant changes in usage over time

Chapter 3

Figure 3.1 The stages of development of a new medicine from new chemical entity to the patient. The numbers are approximate and demonstrate the effort, investment and time required to develop a new drug. Healthcare professionals are primarily involved in the final section (green) and will have significant influence over the success of the product

Chapter 4

Figure 4.1 An example of a drug monograph from the BNF. The monograph illustrates a range of information including the generic/approved name of the drug (Fluoxetine) and the brand/trade name (Prozac®). Source: British National formulary (BNF)
Figure 4.2 The non-proprietary and brand names applied to fluoxetine in the BNF
Figure 4.3 The non-proprietary, brand and chemical names of two commonly used medicines
Figure 4.4 Examples of medicines belonging to the phenothiazine family
Figure 4.5 Commonly used medicine name suffixes

Chapter 5

Figure 5.1 The seven base SI units
Figure 5.2 The prefixes for the SI base units. The most commonly used are highlighted in yellow. The typical range of use in healthcare practice is additionally italicised
Figure 5.3 Illustrative examples of biological unit standards for medicinal products

Chapter 6

Figure 6.1 This figure integrates the four main features of pharmacokinetics (ADME) and the main routes of administration of medication. Note that the IV route bypasses absorption and the topical route is used to minimise absorption

Chapter 7

Figure 7.1 This figure illustrates the four main features of pharmacokinetics (ADME) and the main anatomical structures/physiological systems that are responsible for executing those processes. Note that the two-way arrows illustrate that in reality the ADME processes cycle continuously rather than as a linear process

Chapter 8

Figure 8.1 This figure illustrates how the three most common injectable routes of administration deliver the drug through the skin into three distinct depths and tissue types

Chapter 9

Figure 9.1 Diagram illustrating how a transdermal patch works
Figure 9.2 Suggested sites for the positioning of a transdermal patch

Chapter 10

Figure 10.1 A simple membrane-spanning protein
Figure 10.2 A diagrammatic representation of a membrane-spanning protein
Figure 10.3 A second messenger system
Figure 10.4 The step-by-step process of a second messenger system
Figure 10.5 Step-by-step receptor-mediated ion channel

Chapter 11

Figure 11.1 An agonist is any chemical that binds to a receptor and elicits a positive response from the adjoining cell
Figure 11.2 An antagonist is any chemical that binds to a receptor but elicits no response and in fact prevents a response from occurring

Chapter 12

Figure 12.1 An entry from an in-patient medication chart illustrating the key features to be considered when managing PPIs

Chapter 13

Figure 13.1 An entry from an in-patient medication chart illustrating the key features to be considered when managing loperamide. Note: this is often a ‘when required’ medication rather than a regular medication

Chapter 14

Figure 14.1 An entry from an in-patient medication chart illustrating how Asacol MR may be prescribed and some key features to be considered when it is administered

Chapter 15

Figure 15.1 An entry from an in-patient medication chart illustrating how metoclopramide may be prescribed and some key features to be considered when it is administered

Chapter 16

Figure 16.1 An entry from an in-patient medication chart illustrating how isosorbide mononitrate tablets may be prescribed and some key features to be considered when it is administered

Chapter 17

Figure 17.1 An entry from an in-patient medication chart illustrating how some common antiaarhytmic drugs may be prescribed and some key features to be considered when they are administered

Chapter 18

Figure 18.1 An entry from an in-patient medication chart illustrating how lisinopril tablets may be prescribed and some key features to be considered when they are administered

Chapter 19

Figure 19.1 An entry from an in-patient medication chart illustrating how labetalol tables may be prescribed and some key features to be considered when it is administered

Chapter 20

Figure 20.1 An entry from an in-patient medication chart illustrating how furosemide tablets may be prescribed and some key features to be considered when it is administered
Figure 20.2 The nephron
Figure 20.3 Diuretics block the movement of electrolytes from the tubules into the surrounding blood

Chapter 21

Figure 21.1 An entry from an in-patient medication chart illustrating how salbutamol may be prescribed and some key features to be considered when it is administered

Chapter 22

Figure 22.1 An entry from an in-patient medication chart illustrating how antihistamine tablets may be prescribed and some key features to be considered when they are administered

Chapter 23

Figure 23.1 An entry from an in-patient medication chart illustrating how an opioid analgesic and an opioid antagonist may might be prescribed and some key features to be considered when they are administered

Chapter 24

Figure 24.1 An entry from an in-patient medication chart illustrating how zopiclone may be prescribed and some key features to be considered when it is administered

Chapter 25

Figure 25.1 An entry from an in-patient medication chart illustrating how clozapine (an atypical antipsychotic) may be prescribed and some key features to be considered when it is administered

Chapter 26

Figure 26.1 Two entries from an in-patient medication chart illustrating how two different antidepressants (one SSRI and one ‘tricyclic-related’ antidepressant) may be prescribed and some key features to be considered when they are administered

Chapter 27

Figure 27.1 An entry from an in-patient medication chart illustrating how phenytoin (Epanutin®) may be prescribed and some key features to be considered when it is administered

Chapter 28

Figure 28.1 An entry from an in-patient medication chart illustrating how diazepam in the context of CIWA-Ar may be prescribed and some key features to be considered when it is administered

Chapter 29

Figure 29.1 Three entries from an in-patient medication chart illustrating how three different medications may be prescribed to assist with maintenance of abstinence from alcohol and some key features to be considered when they are administered

Chapter 30

Figure 30.1 There are a range of nicotine replacement therapies available that use different means of delivery

Chapter 31

Figure 31.1 The human body can be infected with a vast variety of organisms, from microscopic viruses and bacteria to the parasitic worms and insects that are visible to the naked eye

Chapter 32

Figure 32.1 Two entries from an in-patient medication chart illustrating how co-amoxiclav and gentamicin may be prescribed and some key features to be considered when they are administered
Figure 32.2 Diagram of β-lactam ring structure common to some antibiotics

Chapter 33

Figure 33.1 A graph illustrating the changes in insulin production over the course of a day. The peaks correspond to the increases in insulin produced in response to eating a meal
Figure 33.2 A graph illustrating how a basal-bolus regime of insulin dosing attempts to mimic the pattern of insulin production seen in a healthy individual
Figure 33.3 A graph illustrating how a twice-daily pre-mixed regime of insulin dosing attempts to mimic the pattern of insulin production seen in a healthy individual

Chapter 34

Figure 34.1 An entry from an in-patient medication chart illustrating how antiglycaemics may be prescribed and some key features to be considered when it is administered

Chapter 35

Figure 35.1 An entry from an in-patient medication chart illustrating how levothyroxine may be prescribed and some key features to be considered when it is administered

Chapter 36

Figure 36.1 An entry from an in-patient medication chart illustrating how a hormonal contraceptive (microgynon) may be prescribed, and some key features to be considered when it is administered

Chapter 37

Figure 37.1 A diagram illustrating how warfarin acts on the vitamin K epoxide reductase, preventing the activation of vitamin K that is needed by the vitamin K-dependent carboxylase to activate crucial clotting factors
Figure 37.2 A diagram demonstrating the difference between unfractionated heparin and low molecular weight heparin

Chapter 38

Figure 38.1 An entry from an in-patient medication chart illustrating how some anti-platelet drugs might be prescribed and some key features to be considered when they are administered

Chapter 39

Figure 39.1 An entry from an in-patient medication chart illustrating how allopurinol or indometacin may be prescribed and some key features to be considered when they are administered

Chapter 40

Figure 40.1 An entry from an in-patient medication chart illustrating how NSAIDS may be prescribed and some key features to be considered when it is administered

Chapter 41

Figure 41.1 Single fingertip unit (FTU) – the quantity of cream that is squeezed onto a patient’s fingertip from the crease of the first knuckle to the tip of the finger
Figure 41.2 The number of FTUs that should be used to cover various regions of the body

Chapter 42

Figure 42.1 An entry from an in-patient medication chart illustrating how topical steriods may be prescribed and some key features to be considered when it is administered

Chapter 43

Figure 43.1 An entry from an in-patient medication chart illustrating how finasteride or bromocriptine may be prescribed and some key features to be considered when it is administered
Figure 43.2 An illustration of the effects of medication on the health and well-being of the foetus and mother through the stages of gestational development. The figure illustrates that medication taken during the gestational period can influence the child’s development after birth (breastfeeding and the milestones attained in childhood)

Chapter 44

Figure 44.1 Some considerations for using medications in children
Figure 44.2 A typical label for a medicine (in this case paracetamol prescribed for a child)

Chapter 45

Figure 45.1 Some considerations for using medications in older patients

Chapter 46

Figure 46.1 An entry from an in-patient medication chart illustrating two medicines’ management considerations for renal and hepatic impairment, how they may be prescribed and some key features to be considered when they are administered

Chapter 47

Figure 47.1 An entry from an in-patient medication chart illustrating an interaction between two drugs. The excretion of lithium is adversely affected by the NSAID naproxen and the two drugs are usually not co-administered
Figure 47.2 Types of drug interactions

Chapter 48

Figure 48.1 An entry from an in-patient medication chart illustrating the prescribing of the antipsychotic medication clozapine and the co-prescribing of three other drugs that are used to manage the side effects of clozapine

Chapter 49

Figure 49.1 ‘Yellow Card’ notification for suspected adverse drug reactions.

Chapter 50

Figure 50.1 A range of medications and their different strengths and dosages in different classifications

Preface

The main aims of this publication are twofold: to introduce pre-registration nursing students to the principles of managing medicines and to aid more experienced nurses (and other healthcare professionals) to develop a better sense of the breadth and depth of medicines management.

In order that standards of teaching and learning and curriculum delivery are equitably set across all universities, the Nursing and Midwifery Council (NMC) oversees the accreditation of nursing curricula. Despite this, there will be varying emphasis on the importance of each of the many subject areas that make up the knowledge base of nursing. The nurse's knowledge of pharmacology will vary significantly for a variety of reasons. Many nurses will not have formally studied pharmacological science in their training and we hope this book will offer a gateway to pharmacological knowledge, which is key to managing medicines.

Many pharmacology texts consider the subject in great depth and offer insight into the development of basic pharmacological science through to complex evidence-based clinical pharmacology. This book attempts to look directly at pharmacology, and its impact on clinical practice and on managing medicines safely and efficaciously. It often refers to the important cardinal resources of medicines management such as the British National Formulary (BNF), the NMC standards and the summary of product characteristics (SPC) of the medicine. These resources should be read alongside this text to gain further perspective on the use of medicines in modern health care. The text does not aim to replace these resources but we hope it will assist in understanding their importance and offer critical consideration of their use. In addition the book, while accurate and up to date, does not replace guidelines, protocols and other evidence-based texts. Professional judgement and up to date knowledge should always be applied in making clinical decisions directly affecting the health and well-being of patients.

The book covers a range of topics and is not designed for one branch or field of nursing practice. A range of fundamental medicines management principles and therapeutic topics are considered and explored. For example, chapters tackling substance misuse should be relevant to most areas of practice but will be more applicable and practically useful to some specific branches of nursing. The size of the ‘… at a glance’ books means that some topics we wanted to cover didn't make the cut. The presence or absence of a topic does not reflect upon the importance of that topic. The topics selected afforded us, as authors, an opportunity to encourage readers to consider applying principles learned to other areas of medicines management.

The charts seen in the therapeutic topics sections are variations of the ‘prescription charts’ seen in hospitals or Medicines Administration Record Sheets seen in care home settings. The lessons learned from these topics apply to managing those medicines across all areas of practice (e.g. in community-based settings). The charts enabled us to share some practical knowledge with regards medicines to administration and management that add value and authenticity to the text.

Throughout the book we have used the terms ‘nurse’ and ‘healthcare professional’. We acknowledge that the term ‘nurse’ could be replaced by the term ‘midwife’ but for brevity we have used the term ‘nurse’. In, addition we have used the term ‘patient’ most often to refer to the person who is taking the medication. We appreciate that terminology varies from practice area to practice area and acknowledge that ‘patients’ are people - just like us. We use the term ‘patient’ not to define the person but to define the responsibility the healthcare professional has for their care. This book, it is hoped, will contribute to a better understanding of medicines and the people who take them. We hope that in some way it will also contribute something positive to managing medicines and to the people who take them.

Finally, Ben and I would like to offer our thanks to those who have supported us in putting this book together. First, we would like to thank the team at Wiley, especially Karen and James, for their dedication, patience and support. Second, we would like to thank all the patients, students and healthcare professionals who have inspired us as practising healthcare professionals and educators. The last and most important thanks go to our families. Special thanks go to our wives, Jess and Tash, who offered us so much support through the entire process. An additional thanks to our inspirational offspring: Jack, Jacob, Lily, Luke and Lydia – this book would not have been possible without you.

Ben Pitcher and
Simon Young

Why is managing medicines important in nursing?

Medicines management and nursing

Nursing is a multifaceted profession. A wide variety of knowledge and skills is required to become a safe and effective nurse in modern healthcare practice. The essential skills clusters (ESCs) of the Nursing and Midwifery Council (NMC) define and illustrate the essential skills that are to be developed by the pre-registration nurse to make that nurse fit for registration. The NMC has developed five clusters of knowledge and skills related to nursing competence:

Care, compassion and communication.
Organisational aspects of care.
Infection prevention and control.
Nutrition and fluid management.
Medicines management.

This book will focus on the medicines management cluster and explore the important medicines-related knowledge required by a nurse. Whenever possible, the ESC will be referenced so that you may consider your knowledge and skill development in that area of medicines management as you work through the book.

Defining medicines management

The Audit Commission report, ‘A Spoonful of Sugar: Medicines Management in NHS Hospitals’ (2001), was designed to highlight the importance of the effective use of medication as a part of the nurse’s role. While nurses’ involvement with medicines management varies according to the context of care (e.g. community based, hospital based), the report highlights that up to ‘7,000 individual doses are administered daily in a “typical” hospital; and up to 40 per cent of nurses’ time is spent administering medicines’ (http://www.eprescribingtoolkit.com/wp-content/uploads/2013/11/nrspoonfulsugar1.pdf, point 11, p.9, last accessed 6 August, 2015).

The report defined medicines management as:

Medicines management in hospitals encompasses the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care.

(www.eprescribingtoolkit.com/wp-content/uploads/2013/11/nrspoonfulsugar1.pdf, Box A, p.5, last accessed 6 August, 2015)

This definition illustrates that managing medicines is not just the responsibility of pharmacists and doctors. It is the collective responsibility of those who work for a healthcare organisation. When working in the NHS, it is easy to find examples of nurses who undertake every facet of medicines management (Figure 1.1). Nurses commonly prescribe, dispense, administer and review patient medication on a day-to-day basis.

The report continues by identifying the main reasons why medicines management needs to continually improve. Medication errors are unacceptably common, the efficacy of medicines is increasing, the costs of medicines are rising and the administration of medicines is becoming more complex. In addition, there is a need to review medicines management across whole health economies as the distinction between primary and secondary care becomes increasingly blurred.

Managing medicines is more than just clinical pharmacology. Clinical pharmacological knowledge is an essential element of safe and efficacious patient care along with the other core skills.

Figure 1.1 is not hierarchical but attempts to illustrate the interconnected nature of the ESCs that make up the medicines management process. Understanding how medicines work (their fundamental pharmacology) is significant knowledge in, for example, medicines administration. Understanding fundamental pharmacokinetics (Chapters 6 and 7) and fundamental pharmacodynamics (Chapters 10 and 11) allow the nurse undertaking medication administration to explain the dose of medication prescribed, its clinical indication, its likely beneficial effects and any potentially important adverse effects such as side effects (Chapter 48) and drug interactions (Chapter 47).

Traditionally, doctors prescribe, pharmacists dispense and nurses administer medication. Modern healthcare practice incorporates increasingly diverse means of supplying medicine: there are growing numbers of prescribers from a range of professional backgrounds (nurses, pharmacists and physiotherapists) and additional ways for patients to access medication – for example, patient group directions (PGDs), which are written instructions for the supply or administration of medicines to groups of patients according to a set of predetermined criteria. The competent nurse needs to understand their role in supporting these mechanisms of medicine supply and in facilitating patient access to increasingly complex treatments as part of evidence-based interventions.

Economic predictions of the cost of medicines in the UK reached a figure in excess of £15 billion by 2015. A proportion of these medicines are established interventions for frequently occurring conditions that reflect the general ill health of the nation. However, some of the costs relate to newer pharmacotherapeutic innovations. Many medications currently used are aimed at preventing the serious consequences of untreated pathophysiological states (e.g. treating hypertension to prevent the cardiovascular consequences of the condition). This presents the NHS with a challenging future with regard to medicines selection and use. Increasingly, medicines use in practice is guided by nationally generated evidence such as National Institute for Health and Care Excellence (NICE) guidelines and technology appraisals. Royal Colleges and collectives such as the Faculty of Sexual and Reproductive Health also produce useful guidance with regard to medicines management. More and more, these guidelines are forming the fundamental basis for medicines choice in practice. Their aim is to ensure the equitable treatment of patients, and that the benefits to patients are optimised and the risks minimised.

The philosophy of managing medicines is increasingly attempting to engage patients in medication choice. Much of the guidance that relates, for example, to medicines choice in mental health aims to put the patient at the centre when selecting pharmacotherapies. In so doing, the aspiration is that adherence (the extent to which patients take medication as prescribed by healthcare professionals) will be increased.

Providing truly holistic care in nursing practice means appreciating both the art and the science of managing medicines.